Pedal and distal lower leg bypasses with a distal arteriovenous fistula

In forty patients 41 feet were revascularised by means of distal tibial (the distal 10 cm of the lower leg) (17) or pedal bypasses (24). Angiographically the preoperative state was best defined as a lower leg block (LLB); All three arteries showing occlusions at several levels, leaving only isolated functioning arterial segments in the distal leg or foot with relatively good femoral and popliteal arteries. As might be expected this condition was mainly found in diabetics (75%). Only feet with severe rest pain (4) or rest pain with gangrene (37) were operated upon. To improve the distal outflow a side-to-side arteriovenous fistula (AVF) was added to the distal anastomosis. With a mean follow-up of 21 months (1-40 months) the limb salvage rate was 79% and the patency rate 67%. Special problems were experienced with cellulitis of the foot, causing the loss of three feet despite an open bypass and sufficient revascularisation. Furthermore, occlusion of the bypass after healing of the lesion did not necessarily mean a recurrence of gangrene. As this series shows, even in angiographically apparently hopeless cases, a bypass to the foot can prevent an otherwise unavoidable amputation.     

7TM receptors: the splicing on the cake.

Within a given family of seven transmembrane domain (7TM) receptors, functional diversity is most often afforded by the existence of multiple receptor subtypes, each encoded by a distinct gene. However, it is now clear that the existence of introns in genes encoding some members of a receptor family provides scope for additional diversity by virtue of splicing events that result in the formation of different receptor mRNAs and consequently distinct receptor isoforms. A large number of 7TM receptor splice variants have now been shown to exist. In this article, the current data on alternatively spliced variants for hormone and neurotransmitter 7TMs are reviewed, their potential physiological importance considered and some of the issues pertaining to the classification and nomenclature of receptor isoforms produced in this way are addressed.     

Therapy-related classical Hodgkin lymphoma after a primary haematological malignancy: a report on 13 cases

The risk of developing Hodgkin lymphoma (HL) is increased in immunodeficiencies or during the treatment of some autoimmune diseases. The development of new therapeutic agents has highlighted the risk of unusual lymphoid proliferations, particularly classical HL (cHL). We report the clinicopathological findings of 13 cHL arising in patients treated for a primary haematological malignancy. Eight patients had received an immunomodulator, protein tyrosine-kinase inhibitor or monoclonal antibody, which may have contributed to the cHL development. Most patients had disseminated disease with poor prognostic factors at cHL diagnosis. Despite the initial presentation, good outcomes were achieved with standard cHL chemotherapy.